Provider Demographics
NPI:1457442121
Name:LAURA WILLIAMS MD
Entity Type:Organization
Organization Name:LAURA WILLIAMS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:951-696-4009
Mailing Address - Street 1:25102 JEFFERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1707
Mailing Address - Country:US
Mailing Address - Phone:951-696-4009
Mailing Address - Fax:951-696-8448
Practice Address - Street 1:25102 JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1707
Practice Address - Country:US
Practice Address - Phone:951-696-4009
Practice Address - Fax:951-696-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76077261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10977784OtherCAQH #
CA1861482531OtherNPI INDIVIDUAL #
CA00G76077Medicaid
CA05D1051900OtherCLIA ID #
CAG76077OtherMEDICAL LICENSE #
CABW6985949OtherDEA #
CABW6985949OtherDEA #
CA10977784OtherCAQH #